Welcome! The first responders will be getting to you shortly, but here are a couple of things to think about.
Looks like your boy is uncontrolled Cushings (PPID), and more than likely insulin resistant (IR). Not only can the PPID drive the IR, Arabs are notoriously easy keepers, and can be IR even without the PPID, so he has a double whammy happening. Fortunately, there is a good chance of getting him comfortable and happy again. Here is a nutshell view of what should be done, then I will address the individual bits of your message.
We recommend Diagnosis, Diet, Trim and Excercise.
Diagnosis of PPID is by ACTH,(which you have done); IR is by non-fasting insulin and glucose draw.
Diet: Low sugar/starch grass hay, tested so that the minerals can be balanced to the hay. Alternatively, Ontario Dehydrated Timothy Balance cubes (ODTB) as a forage source, plus some low s/s hay to play with, if necessary. While waiting on test results, soak the hay 1 hour in cold water or 1/2 hour in hot water, drain and feed. NO pasture, grains, sweet feeds, carrots or other treats. Feed rinsed/soaked/rinsed beet pulp to carry meds and minerals. You can also use Ontario Dehydrated Timothy Balance cubes, lavender label (ODTB cubes) for the same purpose, and for treats. Add 1-2 tablespoons iodized salt, 2 oz ground flax, 1/2 tsp magnesium oxide, and 2,000 IU Vitamin E (in soy/lecithin capsules). This is the temporary emergency diet, and often helps a huge amount.
Short form: soaked hay, salt, Vit E, flax, magnesium, ODTB cubes and/or r/s/r beet pulp, meds and minerals and NOTHING ELSE. (except freely available water, of course)
Trim: This is so important: short toe, low heel, to bring the coffin bone into a more ground parallel state. Often these horses need to be trimmed every 2 weeks at the beginning, so remove the shoes, use boots as necessary. Long walls exacerbate any pain; you may find he is greatly relieved once the correct trims start.
Exercise: only as able, and obviously not at the moment! Laying down is good - it gets him off those feet for now. In the acute stages, making him comfy with deep bedding, hoof boots, and access to a dry lot area where he can wander at will are all good.
>>He eats triple crown safe starch <<
TC Safe Starch forage is indeed low in sugars and starch; sadly, it is too high in pro-inflammatory omega 6 fats (veggie oil and rice bran), and has not any extra source of omega 3 fats (as in flaxseed). Additionally, it has added iron, which we don't want, as many Cushings/IR horses are iron-overloaded, a condition that makes the laminitis worse. If he can't eat hay, ODTB cubes are the best choice.
**** Better choice than the Purina Senior - small handful should be okay.***he was on purina senior but i switched him to purina low starch very small handful with his pergolide.<<
*** Sounds like pergolide might still be too low. Even if you can't re-test ACTH at the moment, I would increase his pergolide, by .25 mg every 4 days, til you get to 3 mg. Some horses need their base pergolide doubled during the seasonal rise of ACTH.***He was getting 1 mg pergolide. In july 2010 his ACTH 63.6 we increased perg to 1.25mg. Did new ACTH 98.8 increased perg to 1.75mg.<<
***I realize a lot of people use banamine and bute at the same time, but they are both non-steroidal anti-inflammatories, so using both increases the chances of stomach ulcers. If possible, reduce the and the banamine by the following protocol: for 2 days, go to once daily; then for three days, once every 36 hours; then 1/2 dose in 36 hours; then no more bute. Banamine doesn't generally help much with foot pain, it is more effective with gut pain, so I would just stop the banamine. (Eleanor, you may have better info on this)***Took more xrays no change. He is on cimeditine, ixsosuprine, 750lb banamine 2x aday and 1 gram bute 2x a day. Was on 900lb banamine just lowered it.<<<
**Gotta love arabs! At the age of 22, there are lots of good years for him yet.***He is 1989 arabian gelding.<<
**Excellent!***I just ordered the soft ride boots.<<
***Laying down is good! Let him stay off his feet, if he needs to. There have been horses on this list that layed down, and stayed down, to the point where the owners were using disposable diapers to prevent bedsores - they eventually recovered.****I hgave owned him for 16yrs and never seem him lay down. He lays down every night now. <<
Remember to breathe! Take care of yourself, too. I can still remember when my two went down with laminitis within weeks of each other. I am a small animal vet, so you would think I could figure out what the heck was going on, with input from our horse/large animal vets. Not so! My poor horses were laying down, groaning, on bute, all the while I was encouraging them to eat the very thing that had set them off in the first place. I am so glad I found this list - I was just mortified that none of my textbooks or vet info that I had available to me had helped.
Overwhelming, I know, but it will get better.
Jaini (BVSc)Merlin, Maggie, Gypsy